Project Summary West Virginia has a tragic legacy of occupational and environmental disasters. Historically, these include names such as Hawk's Nest (arguably one of the largest outbreaks of fatal occupational disease in US history) and Willow Island (the highest number of fatalities in a construction-related accident). As the recentl famous names of Sago, Upper Big Branch, and Elk River demonstrate, this legacy continues. It is therefore not surprising that, according to the most recent Census of Fatal Occupational Injuries from the Bureau of Labor Statistics, West Virginia exceeds national averages in all areas. For U.S. workers in 2012, the rate of fatal occupational injuries was 3.2 per 100,000 workers while in West Virginia it was more than two- fold greater at 6.9 per 100,000 workers. Nowhere in the United States is the need for trained occupational safety and health professionals greater than here. The Appalachian Training Program in Occupational Health and Safety at West Virginia University (WVU) therefore serves a critical need to supply qualified occupational health and safety professionals for our state and region. Our specific goal is a practical one: to train professionals who understand hazardous workplaces and who are prepared to serve in a front- line capacity to prevent, mitigate, and manage workplace injuries and disease. We emphasize the recruitment and training of graduates who will be committed to remain within the Appalachian region. The Appalachian Training Program in Occupational Health and Safety provides Master's level training in Industrial Hygiene (IH), both Master's and Doctoral-level programs in Occupational Safety and Health Engineering (OSHE), and an Occupational Medicine Residency (OMR) for physicians. Although this is not an Education and Research Center (ERC), it is one of only three NIOSH-supported Training Project Grants to offer multiple programs. The OMR has been supported by NIOSH since 1988, the IH program since 1980 and the OSHE program since 2005. It is difficult to overstate the importance of these programs to Appalachia, defined by the Appalachian Regional Commission as a 205,000 square-mile area with approximately 25 million people extending from southern New York to northern Mississippi. This is the only OMR in the entire region, and there are only two other NIOSH-supported programs providing training in IH and three in OSHE. Not only do these programs serve critical regional needs for qualified occupational health and safety professionals, but this grant helps connect programs based within the Benjamin M. Statler College of Engineering and Mineral Resources (CEMR) to those of the Robert C. Byrd Health Sciences Center (HSC) and form the nucleus around which larger activities are built, such as broader educational outreach, research, clinical service, workplace evaluation and control efforts, and national/international faculty recruitment and retention. All three programs benefit not only from the resources of a large, land-grant university but a close relationship with all thre Divisions of NIOSH-Morgantown, the only such facility in the country located on a university campus and adjacent to the HSC.